A 32-year-old woman at 34 weeks gestation with complete placenta previa is admitted to the labor and delivery unit with painless bright red vaginal bleeding. Her vital signs are: BP 110/70 mmHg, HR 88 bpm, RR 18/min, temperature 98.6°F. The fetal heart rate shows a baseline of 140 bpm with good variability. What is the nurse's priority action?

Complete bed rest and continuous fetal monitoring are essential for placenta previa management to prevent further bleeding and ensure fetal safety. Other options (vaginal exam, IV insertion, Trendelenburg) are contraindicated or secondary.

Clinical Judgment The core of this question is determining the priority action when a patient with Placenta Previa experiences painless, bright red vaginal bleeding. The patient has stable vital signs and a normal fetal heart rate. This suggests that it is not a situation requiring immediate emergency surgery, but rather one where pregnancy should be maintained through conservative management and monitoring. Therefore, the nurse's top priority is to prevent further bleeding and continuously assess the fetal status. Option 4 is an action that fulfills both of these. The side-lying position improves uteroplacental blood flow and reduces vena cava compression, while complete bed rest and continuous monitoring allow for early detection of deterioration.

Memory Tip The core management principle for placenta previa is "Hands Off, Monitor, Lie Sideways." Remember: Hands Off (no vaginal exams), Monitor (fetal monitoring), Lie Sideways (side-lying position).

KR vs US The basic principles of placenta previa management (no vaginal exams, conservative management, preparation for cesarean section) are the same in both Korea and the US. However, the US NGN exam tends to emphasize non-invasive intervention and continuous evaluation as the initial management for a 'stable' placenta previa patient. When vital signs are stable and the fetal status is good, the key assessment point is to approach systematically without rushing.

Clinical Practice Guide
The core of nursing care for patients with placenta previa hemorrhage is to monitor fetal health while minimizing additional stimulation and bleeding. In the initial stages, a systematic approach is required as follows:
1. Absolutely prohibited: Any actions that examine or stimulate the cervix (except for transvaginal ultrasound).
2. Monitoring vital signs and bleeding amount: Regularly assess vital signs, the amount/color/characteristics of vaginal bleeding, and pad count.
3. Fetal monitoring: Detect fetal distress (loss of variability, bradycardia, late decelerations) early through continuous fetal heart rate monitoring.
4. Position management:
* Lateral position (left side recommended): Maximizes uteroplacental blood flow and prevents vena cava compression.
* Trendelenburg position is contraindicated: This position can compress the diaphragm and hinder breathing, increase intracranial pressure, and worsen bleeding by increasing pressure on the placenta.
5. IV and lab preparation: Securing a large-bore intravenous line and blood type testing and crossmatching are important, but if the patient is stable, they are 'next priority' actions that can be performed immediately after setting up lateral positioning and monitoring.

Caution
* In SATA (Select All That Apply) questions asking "nursing interventions to perform for a placenta previa patient," never select vaginal examination and Trendelenburg position. These can cause fatal bleeding.
* "Painless bleeding" is a typical symptom of placenta previa, and "painful bleeding" is a typical symptom of placental abruption. However, the two conditions are not always clearly distinguished, so do not diagnose based solely on symptoms and manage comprehensively.